Doctors Behaving Badly May Drive Nurses Away
Thu Jun 6,10:39 AM ET
By Merritt McKinney
NEW YORK (Reuters Health) - Even though the US is in the middle of nursing crunch, with an estimated 126,000 unfilled nursing positions, many physicians do not realize that their own bad behavior may be driving some nurses from the field, according to the results of a new survey.
"One of the things we are concerned about is the nursing shortage," the report's author, Dr. Alan H. Rosenstein, the medical director of VHA West Coast in Pleasanton, California, told Reuters Health. As administrators struggle to deal with the ramifications of the nursing shortage, they must focus not only on recruiting new nurses to the field but also on retaining current nurses, he said in an interview.
The relationship that physicians have with nurses can have a "profound" effect on whether nurses choose to stay in the field, he said.
Many doctors seem unaware of that, suggest the results of the survey of 1,200 nurses, physicians and hospital administrators. Though nearly 93% of all respondents had witnessed disruptive behavior by a physician, doctors were significantly less likely than nurses and executives to believe that such incidents have an important influence on nurses' morale, according to a report in the June issue of the American Journal of Nursing.
About 31% of all respondents knew of a nurse who had left their hospital as a result of a physician's disruptive behavior.
Nurses were also more likely than physicians to believe that doctors do not value their input and collaboration as much as they should. And nurses were more likely than doctors and executives to feel that nurses do not have enough administrative support to deal with conflicts with physicians.
Nurses reported several barriers to reporting problems with physicians, including intimidation, concerns about retaliation and a belief that nothing would be done about the complaint, the report indicates.
Solving the problem will require a "multifaceted approach," according to Rosenstein. Doctors and administrators "must make an effort to cultivate a more supportive environment, one in which nurses and nursing care are valued and respected."
However, other factors that contribute to low morale among nurses, such as cutbacks, scheduling issues and mandatory overtime, must be dealt with, the California physician added. Educational programs aimed at fostering better relationships between nurses and physicians "can't be successful if the underlying factors aren't first addressed," he concludes.
But Dr. Diana J. Mason, the editor of the journal, disagrees that troubles in the nurse-physician relationship cannot be worked out until other problems are tackled. There are several steps that can and should be taken right now, she notes in an editorial that accompanies the study.
Among other things, Mason suggests that hospitals study the state of nurse-physician relationships on their own wards and adopt a "zero-tolerance" policy towards all abusive employees. And nurses should be helped to develop the skills needed communicate effectively with physicians, Mason suggests.
In addition, Mason states, "Nurses should stop referring to physicians as 'Doctor So-and-So' while physicians address them by first names. Whether we use last or first names, we must stop perpetuating such inequality."
And nurse-doctor relationships can also affect patient care, Mason told Reuters Health in an interview. "We have research documenting that communication between nurses and physicians strongly shapes patient outcomes." She cited a 1986 study that found the nurse-physician communication was the leading predictor of patient mortality in intensive care units.
"Nurse-physician communication is not just a matter of 'let's be polite to each other,"' Mason said. "It's a matter of true teamwork with mutual respect for each provider's expertise that he or she brings to a patient's care."
In the interview, Rosenstein said that he did not mean that immediate steps should not be taken to improve relations between nurses and doctors. Instead, he said it is important to realize that this issue is just one of several related to nurses' morale.
"This is one piece," according to Rosenstein. "Other pieces have to be dealt with" as well, he said.
SOURCE: American Journal of Nursing 2002;102:7,26-34.
Jun 13, '02
When I posted: This is a pretty well founded belief...sad to say...but it's true!" This meant the fact that nurses feeling that reporting the offensive behavior of "some" doctor will have no effect! D/t the fact that many admins believe the doc they should for whatever reason excuse the doc behavior, because he is under stresss.. blab, blab. I did not mean that nurses shouldn't speak up for themselves!
Now as for doctors in general thinking that nurses are beneath them...I have found few who believe or act this out! There are times when an MD has been rude or inconsiderate...but not as a rule!
I have met many, many doctors, I have truly had an indepth conversations with, and I'm friends with MDs in many different fields. I have had a doctor join me for lunch...many times while sitting alone in the cafeteria...or give me a ride home...while my car was on the frizz! I have been invited to their homes for gatherings....and been the benefactor of hugs..and pats on the back. But totally ignore me...very rare! Yes...there are some I truly, could beat some sense into their puny heads...but this isn't uncommon as to any other profession! I have many doctors say hello just walking out of an elevator, or going down the halls! There are doctors I have to joke with me...or I joke with them...and not even know their names! But there are stressful times....when I do make allowances for rudeness...just as I do for my fellow nurses.
The chief of Surgery at a major trauma center and I got into a shouting match...mostly him shouting once...about a pt I thought needed another H&H! He had a shattered leg and I felt he had lost a great deal of blood since first having his rainbow drawn. He DIDN'T ...I persisted..and yes he was the one who ended up squeezing the bag with his own hands to get blood into this guy!! When I transferred him to the unit...he sheepishly apologized...and started making small talk. His whole demeanor had changed! He never hollered at me again...and always asked "How's it going?"
I agree that nurses must not allow themselves to be berated..by those who call themselves doctors, and acted inappropriately. I also agree that nurses set themselves up for this behavior when they don't stop them in their tracks! Had a MD start talking to me, as if I didn't have a clue...and we stood there face to face..and I told him just what the deal was...and if he had a problem about it...he needed to talk with his parner who was made full aware of the pts conditions, drips, and meds being given...and if he didn't ordered something he should have...then he needed to talk to HIM...NOT me! My charge nurse and fellows nurses all shifted to the far side of the room during this "conversation"...and if wasn't until this MD calmed down and APOLOZIED...did my CN come over to my side!!!
I have also had nurses get pissed with me...because I had the nerve to talk to a doctor about more than just his PT!!
I have asked and got assistance from MD's I knew in helping me with a project for Head Start. Not only did an group of physican lend me assistance...but they also brought their staffs to a health fair I organized! Three even volunteered to be on the health committee...one was made president, and agreed to serve!
I think the straw bends both ways...and admin needs to not cuddle up to badly behaving MDs...and nurses...need to speak up for themselves. Because as some have also said...if you don't stand up for yourself..why should anyone listen to you whinning about it after the fact??
Last edit by Brownms46 on Jun 13, '02
Jun 14, '02
<Come to think of it...why do nurses refer to doctors of their patients as Doctor so-and-so while the docs call us by our first names>
where I work, many of the RNs call the interns, residents, & even younger attendings by their first names 'cause they call us by our first names. Most of us address the older attendings more formally - I think out of respect for our elders, like youd call the old lady next door Mrs Whatever. Many of those older MDs also address us more formally too. But one middle aged, Napoleon complex type MD insisted on calling one RN who is older than him Ellie - even though she had told him time & again that her name was Ellen & not to address her as Ellie. When he persisted, she started loudly & constantly calling him Mickey (his first name is Michael). Soon after that, he began addressing her as Nurse Smith & still does, &, her point made, she went back to calling him Dr Jones.
Last edit by -jt on Jun 14, '02
Jun 14, '02
The research study that is discussed in that article above appears in AJN this month. Its very detailed & eye-opening. Interesting to see the differences in perception between nurses, physicians, & hospital administrators. The things that a high percentage of nurses found to be problematic with the doctors were many times not considered to be a problem at all by doctors. Some things that were found to be problems by the nurses & the physicians about the facility were of no concern to the administrators. Its glaring how far apart we are in viewpoint when you see the actual questions & the answers of each group side by side. The article doesnt do the study justice. Check it out in full in the AJN. Its so obvious in from the study that nobody is seeing anything from where the nurse is standing. No wonder they all look at us & say "whats your problem?" They truly dont get it. For instance, nurses objected to doctors yelling, being rude, & abrasive & felt that that behavior was unprofessional, disrespectful to them & unnecessary. Doctors said they were merely being "domineering & demanding" & that was necessary in order to make sure their orders were carried out appropriately & timely. Solutions were outlined and were feasible. Will they ever get implemented? Who knows. Maybe this study should appear in the AMA & AHA journals as well. Just in case it isnt, Im copying it from my AJN issue & sending it to our DON, the VP of Physicians, & CEO.
Last edit by -jt on Jun 14, '02